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Pharmacology > Pharmacology of the Peripheral Nervous System > Flashcards

Pharmacology of the Peripheral Nervous System Flashcards

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1
Q

drugs that affect the ANS are used in what

A
  • anesthesia and emergency medicine
  • treatment of allergic reactions, cardiovascular disease, gastrointestinal/urologic disorders, asthma, psychiatric disorders, and glaucoma
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2
Q

adverse rxns to PNS drugs are due to

A

expression through interactions with receptors in the ANS

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3
Q

drugs that directly affect somatic responses at skeletal muscles are used when?

A
  • during surgical procedures and in the ICU to limit movement
  • in treatment of myasthenia gravis
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4
Q

see slides 2&3

A

see slides 2&3

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5
Q

where do neurohumoral transmissions occur

A

btwn nerve cells (across synapses) and btwn nerve cells and effectors cells (across neuroeffector junctions)

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6
Q

what are the 2 major neurotransmitters in the PNS

A
  1. Acetylcholine (ACh)

2. Norepinephrine (NE)

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7
Q

what are the steps in neurotransmission

A
  1. synthesis of neurotransmitter
  2. sotrage of neurotransmitter
  3. release of neurotransmitter
  4. receptor binding (recognition) of neurotransmitter
  5. inactivation of neurotransmitter
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8
Q

see slide 6

A

see slide 6

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9
Q

what type of neurotransmitter is acetylcholine

A

a cholinergic

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10
Q

where is acetylcholine stored

A

in synaptic vesicles via a proton antiporter

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11
Q

see slides 8-12

A

see slides 8-12

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12
Q

what are the adrenergic receptors

A

alpha1, alpha2 (3 subtupes each)

beta1, beta2, beta3

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13
Q

what are the cholinergic receptors

A

nicotinic receptors: Nn, Nm (sodium channels compromised of 5 subints)

muscarinic receptors: M1,M2,M3,M4,M5

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14
Q

where are alpha 1 receptors located

A
  • vascular smooth m.
  • pupillary radial m.
  • genitourinary smooth m.
  • sphincters
  • pilomotor smooth m.
  • sweat glands
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15
Q

what are the physiological responses of Alpha 1 receptors

A 
Contraction (vasoconstriction;  TPR)
Contraction (dilates pupil)
Contraction
Contraction
Contraction (erects hair)
Secretion
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16
Q

where are alpha 2 receptors located

A 
Some vascular smooth muscle
Presynaptic (NE, some ACh nerves)
Platelets
Pancreas
CNS
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17
Q

what are the physiological responses of Alpha 2 receptor

A 
Contraction (vasoconstriction)
Inhibits NT release
Aggregation
Inhibits insulin release
Multiple sites ( sympathetic outflow)
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18
Q

see slides 14-21

A

see slides 14-21

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19
Q

what are the catecholamines

A
  1. epinephrine
  2. norepinephrine
  3. dopamine
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20
Q

what are the uses of Epinephrine

A

Anaphylaxis, Vasoconstrictor added to local anesthetics, topical hemostatic, cardiac rescue

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21
Q

what are the uses of norepinephrine

A

blood pressure support

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22
Q

what are the uses of dopamine

A

severe CHF; cardiogenic/septic shock

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23
Q

see slide 23

A

see slide 23

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24
Q

what are the types of Adrenergic Agonists

A
  1. direct
  2. indirect (amphetamine, tyramine)
  3. mixed (ephedrine)
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25
the clinical effects of alpha receptor agonists are due to what
activation of alpha-adrenergic receptors in vascular smooth m.
26
what are the clinical effects of alpha receptor agonists
- peripheral vascular resistance is increased - blood pressure is maintained or elevated - useful in some patients with hypotension or shock - also are used topically as nasal decongestants
27
what are the direct acting Alpha-1 Selective agonists
- Phenylephrine - methoxamine - several "azoline" derivaties
28
what are mixed acting Alpha-1 Selective agonists
Metaraminol
29
what is the therapeutic use of alpha-2 selective agonists
- used for the treatment of hypertension (topically in opthalmology) - capacity to lower BP results from activation of alpha2- receptors in the CV control centers of the CNS which suppress the outflow of sympathetic nervous system activity form the brain
30
what are the adverse effects of alpha-2 selective agonists
dry mouth and sedation
31
name 3 alpha-2 selective agonists
1. Clonidine 2. Guanfacine, Guanabenz 3. Methyldopa (prodrug)
32
what is the therapeutic use of Beta Receptor Agonists
- treatment of bronchoconstriction in pts with asthma or chronic obstructive pulmonary disease - occasionally used for cardiac stimulation
33
name 2 nonselective Beta Agonists
1. isoproterenol | 2. Epinephrine (also activates alpha receptors)
34
what causes the adverse effects of Beta adrenergic agonists
- stimulation of cardiac Beta-1 receptors | - drugs with preferential affinity for Beta-2 receptors compared with Beta-1 receptors have been developed
35
what are the selective Beta-2 agonists
``` Metaproterenol Terbutaline Albuterol, Pributerol, Fenoterol Bitolterol (prodrug) Salmeterol (long acting) Formoterol (long acting) ```
36
what are the adverse effects of Beta Agonists
Tachycardia, skeletal muscle tremor, restlessness, apprehension and anxiety, increased plasma glucose, decreased plasma K+
37
see slide 32
see slide 32
38
name a noncompetitive, nonselective alpha blocker
Phenoxybenzamine
39
name 2 competitive, nonselective alpha blocker
Phentolamine; Tolazoline
40
name 5 competitive selective alpha1 blockers
Prazosin, Terazosin, Doxazosin, Alfusozin, Tamsulosin (α1A)
41
what are the adverse effects of alpha blockers
- Decrease in peripheral resistance;  mean blood pressure - Increase in heart rate and cardiac output (mediated by baroreceptor reflex; less with alpha1 selective blocking agents) - Improve urine flow in prostatic hypertrophy
42
what are the adverse effects if alpha blocker (continued)
``` Postural hypotension Tachycardia Nasal stuffiness Weight gain Psychomotor slowing in some individuals Inhibition of, or retrograde, ejaculation Epinephrine “reversal”. ```
43
what are the clinical uses of alpha blockers
Hypertension Benign prostatic hypertrophy; urinary flow obstruction Local vasoconstrictor excess (eg, vasoconstrictor + local anesthetic) Pheochromacytoma (temporary symptomatic control)
44
how do Beta blockers differ
- in their relative affinity for beta receptors subtypes and pharmacokinetics - some beta blockers are weak partial agonists of the beta receptors (intrinsic sympathomimetic activity) - some retain a degree of local anesthetic-like (so-call membrane stabilizing) effect
45
see slide 39
see slide 39
46
what are the side effects of beta blockers
- decreased HR - lower BP - enhance cardiac efficiency (improve the balance btwn cardiac oxygen supply and demand) - antiarrhythmic effects - lower intraocular pressure - bronchoconstriction - metabolic effects - exacerbate symptoms of PVD - CNS effects (fatigue, sleep, disturbances, depression)
47
what are the antiarrhythmic effects of beta blockers
- depress SA node - decrease ectopic pacemaker activity - slow atrial and AV node refractory pd
48
what are the metabolic effects of beta blockers
- inhibit lipolysis | - delay recovery from, and mask symptoms of hypoglycaemia
49
what are the clinical uses of beta blockers
Hypertension Supraventricular and ventricular arrhythmias Angina pectoris Hypertropic obstructive cardiomyopathy Post-myocardial infarction (early phase treatment and prophylaxis) Certain patients with congestive heart failure Signs and symptoms of hyperthyroidism Prophylaxis of migraine Treatment of glaucoma Social phobia; performance anxiety Alcohol withdrawal; patients with akathisia
50
see lecture h/o
see lecture h/o
51
see slide 44
see slide 44
52
how is ACh synthesized
choline + acetyl CoA --> Acetylcholine + CoA-SH
53
where is ACh stored
in storage vesicles
54
release of ACh is blocked by what
botulinum toxin; stimulated by spider venom
55
what are the natural alkaloids
1. Muscarine 2. Pilocarpine 3. Nicotinic
56
what is Muscarine isolated from
from the mushroom Amanita muscaria
57
where does muscarine act
almost exclusively at muscarinic receptors
58
where is Pilocarpine isolated from
chief alkaloid obtaiined from the leaflets of S/A shrubs
59
what is the MOA of Pilocarpine
acts on muscarinic agonist
60
what is the therapeutic use of Pilocarpine
- is a MIOTIC agent in the treatment of glaucoma and in the treatment of xerostomia - sweat and salivary glands are extremely sensitive to the drug
61
what type of receptors are nicotinic receptors
ligand-gated ion channels
62
activation of nicotinic receptors cause what
- a rapid increase in cellular permeability to Na+ and Ca++ | - depolarization and excitation
63
what are the 2 agents of Nictonic
- nicotine | - lobeline
64
what are synthetic congeners
chemically related to ACh - undergo slower rate of hydrolysis - clinical uses limited to muscarinic effects of bladder and GI-tract
65
what effects do acetylcholinesterase inhibitors cause
-accumulation of Ach at all cholinergic synapses
66
what is the therapeutic use of acetylcholinesterase inhibitors
- myasthenia gravis - glucoma - paralytic ileus - atony of the urinary bladder - Alzheimer's disease - as pesticides and chemical warfare agents
67
acetylcholinesterase can reverse the paralysis of
competitive NM blockers and reduce symptoms of atropine-like toxicity
68
what are the side effects of acetylcholinesterase inhibitors
- intoxication manifest as an intense cholinergic response ("cholinergic crisis") - effects also exerted on skeletal m. and CNS
69
what are the different classification of AChE inhibitors
competitive reversible alternate substrates; slowly reversible irreversible (organophophates)
70
what are the effects of AChE inhibitors on eye
miosis; blurred vision; spasm of accommodation
71
what are the effects of AChE inhibitors on the GI
salivation; increased secretions; increased tone and motility; urination; vomiting; diarrhea
72
effects of the AChE inhibitors on respiratory tract
- increased bronchial secretions; watery | nasal discharge; bronchoconstriction; weakness or paralysis of respiratory muscles
73
what are the effects of AChE inhibitors on the cardiovascular system
- bradycardia; decreased cardiac output; hypotension; atrial flutter
74
what are the effects of AChE inhibitors on the CNS
tremor; anxiety; restlessness; convulsions; coma
75
what are the effects of AChE inhibitors on skeletal muscle
fasciculation; increased force of | muscle contraction followed by weakness; muscle paralysis due to depolarizing-type neuromuscular blockade
76
which AChE inhibitors are used to treat Alzheimer's Disease
Tacrine (reversible) Donepezil (reversible) Rivastigmine (carbamate) Galantamine (reversible)
77
what is the function of antimuscarinic such as atropine
-reduces the effect of ACh at muscarinic sites
78
see slide 55
see slide 55
79
what are muscarinic receptor antagonists
-are drugs (organic esters) that inhibit the actions of Ach on autonomic cholinergic nerves and on smooth m. cells that lack parasympathetic innervation
80
what drugs are classificed as belladonna alkaloids
atropine and scopolamine
81
what is the MOA of muscarinic receptor antagonists
-are competitive antagonists of muscarinic agonists competing for a common binding site on the receptor
82
what are the effects of atropine at low doses
Slight cardiac slowing followed by slight increases in heart rate, decreased salivation, inhibition of sweating. At moderate does dryness of mouth is pronounced with tachycardia, mydriasis, and cycloplegia
83
what are the effects of atropine at high doses
Reduced tone and motility in GI tract; decrease in vagus stimulated gastric, pancreatic, intestinal and biliary secretions; urinary retention
84
what are the side effects of atropine
Pulse rapid and weak; iris obliterated; vision very blurred; skin is flushed, hot, and dry; ataxia, restlessness, excitement, hallucinations, delirium, coma
85
what are the clinical uses of muscarinic blockers
``` Reduce GI tone/motility and bladder voiding Ocular exams Anesthesia ( ↓ vagal influences) Reverse sinus bradycardia Motion sickness Treat acute mushroom; AChE(-) poisoning Adjunct in Parkinson’s disease Adjunct in bronchial asthma (“tropiums”) ```
86
what are the limited clinical use of ganglionic blocking agents
controlled hypotension; “bloodless” surgical field

Pharmacology (23 decks)

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